The primary purpose of this application is to test the validity, feasibility and efficacy of brief, innovative screening and preventive interventions using fitness and positive image communications for economically disadvantaged high-risk adolescents in an inner-city primary health care setting. This research will: 1) assess the feasibility and validity of a brief multi-health behavioral screening instrument titled the Fitness and Health Behavior Screen (FHBS), using touch screen software for providing tailored behavioral prevention messages; 2) test the feasibility of implementing both a one-on-one consultation and a brief caregiver/parent intervention within a primary health care clinic; 3) examine the efficacy of a cumulative intervention consisting of a brief screen and tailored consultation, with or without a caregiver/parent strategy; 4) examine the impact of re-interventions (i.e., boosters) on enhancing brief intervention outcomes over time; and 5) examine whether the effects of the preventive intervention on marijuana, cigarette and alcohol use were mediated by various drug-specific cognitive, social and environmental risk and protective factors. The long-term objective of this project is to reduce marijuana, cigarette, and alcohol abuse and problems among high-risk older adolescents who are often ignored in prevention research and services. The first phase of this research will involve conducting formative research, including focus groups, instrument surveys, expert panels, and a pre-pilot study, aimed at enhancing the utility, validity and appeal of modified and expanded screening and outcome instruments and tailored youth and caregiver/parent messages integrating marijuana and cigarette smoking, along with existing alcohol messages, into a fitness and physical appearance-themed program. The second phase will involve conducting two studies. The first is a pilot study testing the feasibility of a modified and expanded preventive intervention titled the Adolescent Fitness Image (AFI) Project. The second study is a longitudinal randomized trial examining the efficacy of a brief screen and one-on-one consultation, with or without a caregiver/parent intervention, against a standard care control. This study will also test the effects of re-interventions for enhancing outcomes over time.